Provider First Line Business Practice Location Address:
532 49TH AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LONG ISLAND CITY
Provider Business Practice Location Address State Name:
NY
Provider Business Practice Location Address Postal Code:
11101-5611
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
718-441-8913
Provider Business Practice Location Address Fax Number:
718-846-9064
Provider Enumeration Date:
06/01/2010